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. 2019 Jun 17;19(1):203.
doi: 10.1186/s12884-019-2316-5.

Determinants and underlying causes of frequent attendance in midwife-led care: an exploratory cross-sectional study

Janneke T Gitsels-van der Wal  1 , Lisanne A Gitsels  2 , Angelo Hooker  3   4 , Britte van Weert  5 , Linda Martin  5 , Esther I Feijen-de Jong  5   6
Affiliations

Determinants and underlying causes of frequent attendance in midwife-led care: an exploratory cross-sectional study

Janneke T Gitsels-van der Wal et al. BMC Pregnancy Childbirth. .

Abstract

Background: An adequate number of prenatal consultations is beneficial to the health of the mother and fetus. Guidelines recommend an average of 5-14 consultations. Daily practice, however, shows that some women attend the midwifery practice more frequently. This study examined factors associated with frequent attendance in midwifery-led care.

Methods: We conducted a cross-sectional study in a large midwifery practice in the Netherlands among low-risk women who started prenatal care in 2015 and 2016. Based on Andersen's behavioral model, we collected data on potential determinants from the digital midwifery's practice database. Prenatal healthcare utilization was measured by a revised version of the Kotelchuck Index, which measures a combination of care entry and numbers of visits. Logistic regression models were fitted to estimate the likelihood of frequent attendance compared to the recommended number of visits, adjusted for all relevant factors. Separate models were fitted on the non-referred and the referred group of obstetric-led care, as referral was found to be an effect modifier.

Results: The prevalence of frequent attendance was 23% (243/1053), mainly caused by worries and/or vague complaints (44%; 106/243). Among non-referred women, 53% (560/1053), frequent attendance was associated with consultation with an obstetrician (OR = 3.99 (2.35-6.77)) and exposure to sexual violence (OR = 2.17 (1.11-4.24)). Among the referred participants, 47% (493/1053), frequent attendance was associated with a consultation with an obstetrician (OR = 2.75 (1.66-4.57)), psychosocial problems in the past or present (OR = 1.85 (1.02-3.35) or OR = 2.99 (1.43-6.25)), overweight (OR = 1.88 (1.09-3.24)), and deprived area (OR = 0.50 (0.27-0.92)).

Conclusion: Our exploratory study indicates that the determinants of frequent attendance in midwifery-led care differs between non-referred and referred women. Underlying causes for frequent attendance was mainly because of non-medical reasons.

Implication for practice: A trustful midwife-client relationship is known to be needed for clients such as frequent attenders to share more detailed, personal stories in case of vague complaints or worries, which is necessary to identify their implicit needs.

Keywords: Midwifery; Patient acceptance of health care; Prenatal care; Psychosocial deprivation; Sexual violence; Social determinants of health.

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Conflict of interest statement

The work of Dr. Janneke Gitsels-van der Wal was funded by KNOV Fellowship 2017. The work of the other authors was not funded and they have nothing to disclose.

Figures

Fig. 1
Fig. 1
Eligible study population. The flow chart of the eligible study population
See this image and copyright information in PMC

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